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Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics / WHO international growth reference: implications for child health programmes.
Public Health Nutrition. 2006 Oct; 9(7):942-947.The objectives were to compare growth patterns and estimates of malnutrition based on the World Health Organization (WHO) Child Growth Standards ('the WHO standards') and the National Center for Health Statistics (NCHS)/WHO international growth reference ('the NCHS reference'), and discuss implications for child health programmes. Design: Secondary analysis of longitudinal data to compare growth patterns (birth to 12 months) and data from two cross-sectional surveys to compare estimates of malnutrition among under-fives. Settings: Bangladesh, Dominican Republic and a pooled sample of infants from North America and Northern Europe. Subjects: Respectively 4787, 10 381 and 226 infants and children. Healthy breast-fed infants tracked along the WHO standard's weight-for-age mean Z-score while appearing to falter on the NCHS reference from 2 months onwards. Underweight rates increased during the first six months and thereafter decreased when based on the WHO standards. For all age groups stunting rates were higher according to the WHO standards. Wasting and severe wasting were substantially higher during the first half of infancy. Thereafter, the prevalence of severe wasting continued to be 1.5 to 2.5 times that of the NCHS reference. The increase in overweight rates based on the WHO standards varied by age group, with an overall relative increase of 34%. The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy. Their adoption will have important implications for child health with respect to the assessment of lactation performance and the adequacy of infant feeding. Population estimates of malnutrition will vary by age, growth indicator and the nutritional status of index populations. (author's)
Contraception. 1984 Dec; 30(6):505-22.The World Health Organization (WHO) conducted a randomized comparative trail of th effects of hormonal contrception on milk volume and infant growth. The 341 study participants, drawn from 3 obstetric centers in Hungary and Thailand, were 20-35 years of age with 2-4 live births and previous successful experience with breastfeeding. Subjects who chose oral contraception (OC) were randomly allocated to a combined preparation containing 150 mcg levonorgestrel and 30 mcg ethinyl estradiol (N=86) or to a progestin-only minipill containing 75 mcg dl-norgestrel (N=8). 59 Thai women receiving 150 mg depot medroxyprogesterone (DPMA) intramuscularly every 3 months were also studied. An additional 111 women who were using nonhormonal methods of contraception or no contraception served as controls. Milk volume was determined by breast pump expression. No significant differences in average milk volume were noted between treatment groups at the 6 week baseline visit. However, between the 6th and 24th weeks, average milk volume in the combined OC group declined by 41.9%, which was significantly greater than the declines of 12.0% noted in the progestin-only group, 6.1% among DMPA users, and 16.7% among controls. The lower expressed milk volume among combined OC users did not impair infant growth. No significant differences were observed between treatment groups in terms of average infant body weight or rate or weight gain. Users of combined OCs may have compensated for their decreased milk volume by providing more extensive supplementary feeding or more prolonged suckling episodes. These results suggest that the estrogen content of combined OCs adversely affects the capacity of the breast to produce milk; thus, family planning programs should make nonestrogen-containing methods available to breastfeeding mothers. Although no effects on infant growth were noted in this study, the possibility of such efects cannot be excluded in populations where infant growth largely depends on the adequacy of unsupplemente d lactation.
NATION'S HEALTH. 2001 Apr; 15.One topic discussed at the annual January session of the WHO's executive board was the general health and well-being of young children and mothers. The 32 members met in Geneva for a week to develop policy standards in various issues, including promoting a global strategy for infant and child feeding and nutrition, strengthening nursing and midwifery and making pregnancy safer. The board members adopted a resolution aimed at improving the nutrition of women of reproductive age and supporting breastfeeding. They also stressed the importance of increasing nursing and midwifery work. Other significant issues discussed included epidemic alert and response measures, health services performance assessment, HIV/AIDS, mental health, the Roll Back Malaria program, polio eradication, tobacco control, and schistosomiasis.
BMJ. British Medical Journal. 2001 Mar 3; 322(7285):555.This document discusses the important role of the UN International Children's Emergency Fund UK baby-friendly initiative in promoting and supporting breast-feeding. A survey of 21 baby-friendly hospitals reveal an increase of more than 10% in breast-feeding initiation, with the percentage of babies who are breast-fed rising from 60% 2 years before the units received their baby-friendly award to 70.6% a year after their accreditation. A compounding problem of low breast-feeding uptake is the rapid decline in prevalence, with 75,000 mothers terminating breast-feeding in the first postnatal week each year. Thus, the baby-friendly initiative has adopted the principle of best practice standards so health professionals will be able to support mothers in their chosen feeding method. These standards combine the foundations of good practices (policy, training, information) with changes in practices (skin-to-skin contact, rooming in, exclusive breast-feeding) and good cooperation between different parts of the health service and voluntary sectors.
[The hidden starving. Nutrition in underdeveloped countries] Den dolda svalten: Nutrition v utvecklingslanderna -- ett angelaget arbete.
NORDISK MEDICIN. 1997 Jun; 112(6):204-5.Undernutrition and malnutrition among children and women have diminished in most low-income countries in recent decades except for large parts of Africa. The Swedish International Agency for Development Cooperation (Sida), UNICEF, and the World Bank have financed nutrition projects. The right type of intervention can achieve much for children, especially when breast feeding is promoted. Although the importance of iodine has been known for a long time, the intensive iodination of salt worldwide has been propagated only in recent years. Research has shown that even slight deficiency of iodine leads to reduced ability to learn among children. 23-45% of child mortality could be reduced if the vitamin A needs of children could be assured. A combined strategy of large doses of vitamin A in capsule form as well as vitamin A-rich meals prepared from vegetables is recommended. Iron deficiency affects about half of the women and small children in many countries. Children's learning ability also worsens if iron deficiency is present. In the poorest countries nutritional assistance often falters because of the lack of local capacity to distribute and utilize aid. Sida has been singularly responsible for building up capacity to absorb aid in many African countries. In Ethiopia and Zambia mixed results have ensued, but in Zimbabwe and Tanzania the outcome has been splendid after many years of exertion. In these countries the nutritional status of children has improved in the 1990s despite their stagnating economies. The Tanzania Food and Nutrition Centre is technically the best developed on the continent, while Zimbabwe's Ministry of Health has succeeded in carrying out a nationwide nutrition program, and for most children (nearly 1 million) it provided a feeding program amidst recurring droughts. The promotion of the importance of breast feeding is borne out by the fact that exclusive breast feeding protects children against disease and stunting.
JORDEMODERN. 1987 Jun; 100(6):172-3.As long as breast-feeding in the developing and developed countries is threatened by bottle-feeding and too early introduction of supplementary diets, the discussion about how breast-feeding is best protected must be kept alive within the organizations and the mass media. Representatives of the Swedish private organizations' foreign assistance programs participated in a seminar on April 3, 1987 in Stockholm, arranged by the Nordic Work Group for International Breast-Feeding Questions in cooperation with International Child Health (ICH). Breast-feeding increased strongly in Sweden during the 1970s, but bottle-feeding is still the norm in large parts of Europe and continues to increase in the developing countries. 6 years have passed since the international code for marketing of breast milk substitutes (even called the child food code) was approved by WHO, in 1981. It contains rules that limit companies' marketing efforts and establish responsibilities and duties that apply to health personnel. The application of these rules is slow and differences between company policies and practice exist. In a larger perspective, we are dealing with the position and significance of woman and children within the family and society. During a WHO meeting in 1986, a resolution was adopted that reinforces the content of the code, e.g., it stops the distribution of free breast milk substitutes to the hospital, where free samples are often given to leaving mothers. The WHO countries also expressed negative feeling toward marketing child food during a period where breast-feeding may be affected negatively. How the resolution is going to be implemented in Sweden is not yet known. There are signs that even in Sweden the existence of the code is being forgotten. The seminar participants recommended that the Social Board issue a simplified and easily read reminder about the code for wider distribution in Sweden.
In: Proceedings of the Interagency Workshop on Health Care Practices Related to Breastfeeding, December 7-9, 1988, Leavey Conference Center, Georgetown University, Washington, D.C., edited by Miriam Labbok and Margaret McDonald with Mark Belsey, Peter Greaves, Ted Greiner, Margaret Kyenkya-Isabirye, Chloe O'Gara, James Shelton. [Washington, D.C., Georgetown University Medical Center, Institute for International Studies in Natural Family Planning, 1988].  p.. (USAID Contract No. DPE-3040-A-00-5064-00)In 1986 the European Regional World Health Organization (WHO) Office convened a meeting of health workers' organizations to develop a strategy for implementing breastfeeding promotion. The elements in this strategy are outlined along with the reasons why some countries have seen increases in breastfeeding and a discussion of the possible ways international organizations can help. The "International Code of Marketing of Breast-Milk Substitutes" constitutes the clearest mandate for an "action program" in the field of breastfeeding. It provides a framework for action and for the formulation of a breastfeeding promotion strategy. Further, the "Code" identifies the obligations of both governments and health workers. According to the Resolution recommending the "Code," one of the obligations of governments is to report regularly to WHO on the progress in 5 areas of infant nutrition: encouragement and support of breastfeeding; promotion and support of appropriate weaning practices; strengthening of education, training, and information; promotion of health and social status of women in relation to infant and young child feeding; and appropriate marketing and distribution of breast milk substitutes. The WHO member states in the European Region have taken their reporting obligation seriously; 71 reports from 29 of the 32 members states have been received. The picture that emerges is one of large diversity with regard to breastfeeding both among and within countries. The European Strategy outlines 7 priority areas for action: the basic attitude of health workers; maternity ward routines; the formation of breastfeeding mothers' support groups; ways to support employed mothers who want to breastfeed; research in breastfeeding; commercial pressure on health workers; and the need for advocacy of breastfeeding. The promotion of breastfeeding is the cumulative effect of activities from several different disciplines that becomes evident in the statistics as an increase in breastfeeding. Factors that contribute to an increase in breastfeeding, based on the Scandinavian experience, are outlined. In regard to establishing a breastfeeding policy, the various activities that can encourage and support breastfeeding fall into 3 categories: making breast milk available to the baby by influencing the material conditions of breastfeeding; increasing knowledge either about human milk or about lactation management as well as about changing attitudes and behavior; and assuring the quality of the milk itself. Ideally, an organization with an advisory and to some degree an executive, decision-making function coordinates these activities.
In: Programmes to promote breastfeeding, edited by Derrick B. Jelliffe and E.F. Patrice Jelliffe. Oxford, England, Oxford University Press, 1988. 86-93.The Nursing Mothers' Association was formed in Sweden in the early 1970s, and the group worked to gain access to mass media to influence attitudes through articles and interviews in which they demanded support and encouragement for breastfeeding. A large number of research reports also emerged in the 1970s, demonstrating the benefits and superiority of breastfeeding and breast milk. Further, the active support from international organizations such as WHO and UNICEF was of considerable value as was the controversy leading to the formulation of the Code of Marketing of Breast-milk Substitutes, which helped to focus the interest of the mass media on the issue. Sweden's Board of Health and Welfare appointed an expert group to propose a plan of action, and the group edited a comprehensive textbook on breastfeeding and breast milk to be used as a national guide. The Nursing Mothers' Association developed to a national organization with representatives visiting maternity units and offering to provide advice by telephone after the mother's discharge. 10 years after the rediscovery of breastfeeding there are several hundred thousand mothers with considerable breastfeeding experience. On a limited scale, Sweden has returned to earlier days when young women learned from older and more knowledgeable women. A wealth of personal experience has been gathered and is being conveyed to others in an informal person-to-person manner. Sweden's baby-food industry has adjusted well to the new situation and has accepted a considerable reduction in sales of breast milk substitutes and has complied with the Code. The dramatic increase in breastfeeding in almost all industrialized nations, including Sweden, suggests a strong movement and that breastfeeding is here to stay.
In: Programmes to promote breastfeeding, edited by Derrick B. Jelliffe and E.F. Patrice Jelliffe. Oxford, England, Oxford University Press, 1988. 94-100.The Department of Health and Social Security (DHSS) in the UK established a Working Party of practicing pediatricians, midwives, and health visitors in June 1973 for the purpose of reviewing the then present-day practice in infant feeding. Published in 1974, the Report added an influential and important stimulus to the return to breastfeeding in the UK. The Report acknowledged to manufacturers that due to new technology the composition of artificial milk feeds more closely resembled that of human milk but stressed that the hazards to health for babies were largely due to the dissimilarities between even modified cows' milk feeds and human milk. There also were many different infant milk products on the market, resulting in a problem of choice for the mother and her professional advisors. Due to the fact that instructions for making up a feed varied from product to product, it was understandable that mistakes were made. The Working Party was convinced that an adequate volume of breast milk meant satisfactory growth and development and recommended that all mothers be encouraged to breastfeed. Further, recommendations for the encouragement of breastfeeding covered many aspects of education. The mass media were recognized as an important educational resource which could emphasize the advantages of breastfeeding. Another group of recommendations referred to artificial milk feeds; all such feeds were to approximate in composition as nearly as possible to human milk. Other recommendations advised against the introduction of solid foods before about 4 months of age and against the addition of sugar and salt to solid foods in the infant's diet. The remaining recommendations covered further research into the principles and practice of infant feeding, a review of legislation concerning the composition of artificial infant milk foods, and the collection of national statistics about infant feeding practice. In regard to implementation, recommendations about education are being put into effect slowly and steadily. The government has endorsed fully the aim and principles of a World Health Organization Code of Marketing of Breast Milk Substitutes, which was adopted in May 1981 by an overwhelming majority at the World Health Assembly. The Code emphasizes the importance of breastfeeding. As attitudes and prejudices die hard, continued education of those in the caring professions and the public is necessary.
Mothers and Children. 1985 Nov-Dec; 5(1):5, 7.Currently standards from industrialized countries are used to assess the growth patterns of breastfed infants in developing countries. Infant growth faltering is interpreted as an indicator of insufficient lactational capacity on the mother's part. 2 recent articles suggest the need for a critical reappraisal of current growth standards and their use for evaluating the adequacy of infant feeding practices. The most commonly used standards to evaluate infant growth are derived from the US National Center for Health Statistics based on anthropometric data collected in the US population 3-month intervals up to the age of 3. During this period, infant feeding practices varied greatly. Many babies were bottle-fed and given supplemental feedings early in life. No large sample of exclusively breastfed infants has been studied from birth on, and thus a standard for breastfed infants is not available. A study of fully breastfed infants was done in England and suggests that there are differences in growth rates. Among a population of 48 exclusively breastfed boys and girls, for the 1st 3 to 4 months of life, growth of breastfed infants was greater than National Center for Health Statistics Standards, while after 4 months growth velocity decelerated more quickly than the standard. The growth of infants studied in Kenya, New Guinea and the Gambia appears to falter at 2-3 months of age using the NCHS standard. Findings suggest that current FAO/WHO recommended energy intakes may be excessive. Recent studies in the US support this assertion. The adequacy of the milk production for the infants in this US study done in Texas was illustrated by their growth rates. Length for age percentiles were higher than the NCHS standards throughout the study though at birth they did not differ significantly. 1 reason these breastfed infants were able to maintain growth despite less than recommended energy intakes is that the ratio of weight gain/100 calories of milk consumed was 10-30% higher among the breastfed infants compared to formula fed infants, suggesting a more efficient use of breastmilk than formula. There is a need for studies of exclusively breastfed infants with larger samples to determine what growth pattern should be considered the norm.
Infant and young child nutrition, including the nutritional value and safety of products specifically intended for infant and young child feeding and the status of compliance with and implementation of the International Code of Marketing of Breast-milk Substitutes: report by the Director-General.
Geneva, Switzerland, WHO, March 1983. 39 p.This report to the Health Assembly is presented in 3 parts: Part I--a summary of the present global nutritional situation with particular reference to infants and young children--is based on an initial reading of the results of national surveillance and monitoring activities in over 50 countries. Part II has been prepared in accordance with resolution WHA34.23 which requested the Director-General to report to the Assembly on steps taken to assess the changes that occur with time and under various climatic conditions in the quality, nutritional value and safety of products specifically intended for infant and young child feeding. Part III, in accordance with resolution WHA34.22, summarizes information provided by Member States on action being taken to give effect to the International Code of Marketing of Breast-milk Substitutes. It should be read in conjunction with section VI of the Director-General's progress report which informed the 35th World Health Assembly of action taken by WHO and its Member States in the field of infant and young child feeding. In light of the information on the implementation of the Code contained in these 2 reports, and in the absence of any suggestions from Member States for change, the Director-General considers that it would be premature, at this time, to propose any revision of the text of the Code, either its form or content. The Health Assembly's attention will be drawn, in future biennial progress reports on infant and young child feeding, to any development which may have a bearing on the International Code, in accordance with its Article 11.7 and resolution WHA33.32.